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Minimizing Risks from Fluoroscopic X Rays© A Continuing Education and Credentialing Program for Safe Practice Fifth Edition by Louis K. Wagner, Ph.D., DABR, FACR, FAAPM Keith J. Strauss, M.S., DABR, FACR, FAAPM Benjamin R. Archer, Ph.D., DABR, FACMP, FAAPM www.rmpartnership.com Table of Contents ABOUT THIS MONOGRAPH GETTING STARTED A SHORT HISTORY LESSON THE RECENT PAST EDUCATION RESPONSIBILITIES QUALIFIED USERS COMPONENTS OF TRAINING TRAINING ON SPECIFIC EQUIPMENT PROPERTIES OF X RAYS X RAY VERSUS X-RAY X RAYS AND LIGHT X-RAY IMAGING ALWAYS CAUSES BIOLOGICAL CHANGES RADIATION QUANTITIES AND UNITS RADIATION EFFECTS VERSUS RADIATION RISK ABSORBED DOSE AIR KERMA AND EXPOSURE Free-in-air air kerma Surface air kerma Exposure as a quantity ABSORBED DOSE AT ENTRANCE SKIN SURFACE EQUIVALENT DOSE EFFECTIVE DOSE KERMA-AREA (DOSE-AREA) PRODUCT SUMMARY OF “DOSE” © Copyright 2014 - No part of the monograph may be reproduced without written permission from the authors. BIOLOGICAL EFFECTS CLASSIFICATIONS OF RADIATION EFFECTS Stochastic effects Cancers in patients Cancers in medical workers Radiation-Induced heritable effects Radiation-induced injuries INJURIES TO PRACTITIONERS INJURIES IN PATIENTS RECOGNIZING FLUOROSCOPICALLY INDUCED RADIATION SKIN INJURY RADIATION-INDUCED CATARACT FLUOROSCOPY AND FLUOROGRAPHY X-RAY TUBE KILOVOLTAGE TUBE CURRENT PULSED VERSUS CONTINUOUS FLUOROSCOPY Conventional fluoroscopy Pulsed fluoroscopy Variable pulsed fluoroscopy FLUOROGRAPHY FILTRATION INTERNAL SHIELDING GEOMETRIC COLLIMATION GENRES OF FLUOROSCOPES Mini-C-arms Standard mobile C-arms Table-tower fluoroscopes Fixed-in-room C-arms OPERATOR CONTROL RADIATION MANAGEMENT FOR FLUOROSCOPY #1 ANATOMICAL SIZE OF THE PATIENT Factors affecting dose rate Patient size and dose rates to personnel #2. DOSE-RATE SETTINGS Operational software options Dose rate settings for fluoroscopy Fluoroscopic pulse rate Fluoroscopic dose rate Recorded fluoroscopy Fluorography or acquisition imaging Cineangiocardiography and the cine loop Digital fluorography Special image-guiding techniques Image display © Copyright 2014 - No part of the monograph may be reproduced without written permission from the authors. #3. BEAM-ON TIME AND DWELL TIME Beam-on time Fluoroscopy timer Beam dwell time Fluorography on-time Digital fluorography Cine and the cine loop Aids to reduce beam-on time Beam-on time and doses to personnel #4. PROXIMITY OF PATIENT TO X-RAY TUBE Source-to-patient distance A conundrum The separator cone (or spacer device) SSD and dose to personnel SSD and image quality #5. PROXIMITY OF IMAGE RECEPTOR TO PATIENT Patient-to-image-receptor distance #4 AND #5 TENETS COMBINED Patient dose and physician height Patient dose and invasive devices #6 MAGNIFICATION Field of view (FOV) Image magnification Electronic magnification Geometric magnification #7. THE GRID #8 COLLIMATION X-ray field collimation #9. MONITORING AND MANAGING RADIATION USE #9A. Monitoring radiation use Fluoroscopy on-time Cumulative air kerma at a reference point Air kerma-area product Skin-dose mapping © Copyright 2014 - No part of the monograph may be reproduced without written permission from the authors. #9B. Managing radiation use High-dose procedures Before the procedure Demographic factors Medications Radiation history Diseases or conditions Counseling the patient The special condition of pregnancy During the procedure After the procedure #10. MASTERY OF RADIATION SAFETY Viewpoint Protective aprons Radiation monitoring for personnel Using distance as a shield Leaded eyewear, thyroid shields, and upper body shields Mobile and lower body barriers Hand protection Equipment design safety features Conventional table-tower fluoroscopy Remote control fluoroscopy C-arm fluoroscopy Invasive devices & doses to patient and staff Fluoroscopy with x-ray tube above table Fluoroscopy with x-ray tube under table Pregnant personnel Regulations CONCLUSION REFERENCES INDEX © Copyright 2014 - No part of the monograph may be reproduced without written permission from the authors.
